SHARING CARE - THE PSYCHIATRIST IN THE FAMILY PHYSICIANS OFFICE

Objective: One way of strengthening ties between primary care provider s and psychiatrists is for a psychiatrist to visit a primary care prac tice on a regular basis to see and discuss patients and to provide edu cational input and advice for family physicians. This paper reviews th e experiences of a program in Hamilton, Ontario that brings psychiatri sts and counsellors into the offices of 88 local family physicians in 36 practices. Method: Data are presented based on the activities of ps ychiatrists working in 13 practices over a 2-year period. Data were ga thered from forms routinely completed by family physicians when making a referral and by psychiatrists whenever they saw a new case. An annu al satisfaction questionnaire for all providers participating in the p rogram was also used to gather information. Results: Over a 2-year per iod 1021 patients were seen in consultation by one full-time equivalen t psychiatrist. The average duration of a consultation was 51 minutes, and a family member was present for 12% of the visits. Twenty-one per cent of the patients were seen for at least one follow-up visit, 75% o f which were prearranged. In addition, 1515 cases were discussed durin g these visits without the patient being seen. All participants had a high satisfaction rating for their involvement with the project. Concl usions: Benefits of this approach include increased accessibility to p sychiatric consultation, enhanced continuity of care, support for fami ly physicians, and improved communication between psychiatrists and fa mily physicians. This model, which has great potential for innovative approaches to continuing education and resident placements, demands ne w skills of participating psychiatrists.